# SLEEP MEDICINE ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790813590
- **Authorized official:** DR. RICHARD MAHLON SHOUP M.D. (OWNER)
- **Authorized official phone:** (860) 432-5600

## Contact information

- **Practice address:** 112 SPENCER ST, MANCHESTER, CT 06040-4601
- **Practice address phone:** (860) 432-5600
- **Practice address fax:** (860) 432-5622
- **Mailing address:** 112 SPENCER ST, MANCHESTER, CT 06040-4601
- **Mailing address phone:** (860) 432-5600
- **Mailing address fax:** (860) 432-5622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |
| 2084S0012X | Sleep Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084S0012X | Sleep Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 12/04/2013